Desktop Integration

Rhidian Bramley

PACS & Teleradiology Group Meeting

November 2005

What is Desktop Integration?

• Hardware Integration

• Software Integration– ‘Front-end’ workstation application integration– ‘Back-end’ server side integration

Desktop Hardware Integration

• Technically easy, contractually challenging

• Single physical workstation running all applications

• Single keyboard and mouse

• One or more screens configured as a single virtual desktop.

Desktop Hardware Integration• All functions permitted to the user of the specialty information

solution and PACS shall be available (including digital dictation where installed) through the single workstation with desktop integration.

• Workstation display devices shall be controlled by a single keyboard and mouse.

• The workstations provided for desktop integration shall, according to user preference, be provided in one of the following configurations:– 2 display devices for viewing images and 1 colour display

device for specialty information solution (in the case of radiology, commonly referred to as a RIS).

– 1 display device for viewing images and 1 colour display device for specialty information solution.

– 2 display devices for viewing images with the option of interacting with specialty information solution on 1 of these display devices.

Desktop Hardware Integration

Desktop Software Integration

• Applications– PACS– RIS – Other specialty information systems– Digital dictation system– 3rd party applications e.g. orthopaedic

templating– Electronic patient record application

Software Integration

• Front-end integration (desktop integration)– Client side or application integration– Proprietary as ‘limited’ use of standards– Application Program Interface (API) e.g. COM

• Back-end integration– Server side integration– Standard IHE defined transactions– HL7 & DICOM Interfaces

Front-end integration functions

• Is the other application active?

• Launch/shutdown other application

• Share login and password update, log out

• Show primary patient/studies

• Show additional studies

• Clear studies

• Dictation in progress (recording), stopped

Desktop Integration Specification• There shall be a single log on to the services such that a

user logging on to the PACS shall also be logged on to the specialty information solution and vice versa, where it is appropriate for a user to be logged on to both systems.

• The PACS and specialty information solution (in the case of radiology, commonly referred to as a RIS) application shall be linked in such a way that examination information selected on the specialty information solution display device shall cause relevant images to be shown on the PACS display devices according to the relevant default display protocols (DDPs) and selection of images/examinations on the PACS display devices shall cause the relevant specialty information solution examination data to be displayed on the specialty information solution display device.

Suggested Enhancements

• The PACS and speciality information system worklists should show a list of all scheduled and prior studies on the active patient, indicating the study status, the number of available images for each study on PACS, and which of these studies are loaded on the PACS display device at any moment.

• PACS image display should indicate primary studies to be reported, to distinguish them from additional studies loaded manually or by default display protocols.

• The PACS image display should indicate when recording is taking place during digital dictation.

HL7 CCOW (Clinical Context Object Workgroup)

Radiology Desktop Integration Workflow Questions

• Which application should drive PACS workflow?– RIS worklist?– PACS worklist?

• Which application should drive PACS web client workflow?

• Which application should the digital dictation be tightly integrated with?

Back-end server side integration• Can give integrated desktop experience

– Makes RIS information available through PACS

• E.g. procedure information, status, reports

– Makes PACS information available through RIS

• E.g. availability of images

• Enables either RIS or PACS to provide a worklist to support workflow

IHE Scheduled Workflow Profile

↓ Procedure Scheduled

↓ Procedure Updated

↓ Performed Work Status Update

↑ Performed Work Status Update

↑ Image Availability Query

↑ Instance Availability Notification

Radiology Information System(IHE Department System Scheduler)

PACS (IHE Image Manger/Archive)

IHE Reporting Workflow Profile

Worklist ProviderRIS or PACS?

(IHE Report Manager)

Image ProviderPACS

(IHE Image Manager)

Report Creator RIS or PACS?

Image Display PACS

DICOM GPWL

DICOM Query/Retrieve

Conclusion

• Desktop integration means different things to different people and should be specified clearly in functional terms

• Front-end desktop is limited by lack of an industry standard specification for radiology workflow

• Functionality should be achieved through existing standard back-end integration where possible, but will co-exist with front end integration desktop integration for the foreseeable future.